Atopic dermatitis or atopic eczema is a chronic, relapsing, familial, symmetric and pruritic inflammatory skin disease that commonly presents during early infancy and childhood, but can persist or start in adulthood.
It is commonly associated with elevated serum immunoglobulin E levels and a personal or family history of allergies, allergic rhinitis and asthma.
It is one of the most common skin diseases afflicting both children and adults.

Least potent but effective product should be used, especially if for long-term use

May use mid- and high-potency preparations (except when lesions are on face, groin or axillae) to control acute flares and then follow with lower potency preparations after clinical improvement is seen

May be used on all body locations for extended periods of time, especially the face, hands and feet

All preparations are of a standard potency

There is no evidence of causal link between the use of calcineurin inhibitors and cancer

Preferred over topical corticosteroids when atopic dermatitis is unresponsive to steroid therapy, with presence of atrophy or telangiectasia secondary to steroid use, when affected areas are either the face, anogenital area, and/or skin folds, and for long-term treatments

Also used in patients with inadequate response to other topical therapeutic agents or when such treatments are not advised

Pimecrolimus

Safety and efficacy have been shown in children >2 years of age and adults with mild-moderate atopic dermatitis

Pruritus relief has been seen as early as day 3 of use; does not cause atrophy

Prevents flare-ups and results in significant steroid-sparing effect when used for up to 12 months

When used in early stages of disease, it has shown to be therapeutically advantageous over typical moisturizers plus topical corticosteroids in long-term use

Tacrolimus

Rapidly decreases the signs and symptoms of atopic dermatitis in adults and children >2 years of age

Improvement is seen within 3-7 days of therapy and sustained for at least 12 months

Well-tolerated with transient skin burning/irritation; less incidence of atrophy compared to steroids

Studies have confirmed the efficacy of Tacrolimus 0.03% compared to low-potency topical corticosteroids in children and the efficacy of Tacrolimus 0.1% compared to mid-potency topical corticosteroids in adults

Biologic Therapy

Dupilumab

A human immunoglobulin G4 monoclonal antibody approved for use in patients ≥18 years of age w/ moderate to severe atopic dermatitis

A 10-year retrospective study at Singapore General Hospital (SGH) has shown that majority of patients with tinea unguium, a common nail infection, are aged ≥60 years. In this cohort, patients of Indian and other ethnicities are over-represented for tinea unguium compared to Chinese and Malay patients.